TRANSFORMING THE STUDENT
EXPERIENCE:
Learning through simulation?
Agenda
• Background to clinical education for Allied
Health Professionals (AHPs)
• History of simulation
• Simulation as an adjunct?
• Example
• Future
History and context of medical
education
The Anatomy
Lesson of Dr.
Nicolaes Tulp
Rembrant,
1632
The Anatomy Act did clearly establish to whom a dead body belongs. Until relatively recently, the principle that
the 'only lawful possessor of the dead body is the earth' prevailed in the UK.
Background to clinical education for
Allied Health Professionals (AHPs)
• Apprenticeship
• Socialisation
Apprenticeship
• Historical model of education
• Alder Hey / Bristol enquiry highlighted
problems
• Teaching belies absolute patient care
• Disparity between what the mentor “wants” to
teach and what the student “needs” to learn
Socialisation of students: Situated
learning (One theoretical perspective)
• Shared repertoire / joint enterprise (policy)
• Community of practice
• Mutual engagement (care of patient)
• The stronger students are usually accepted
into the community either through excellent
knowledge and skill demonstration or pure
belligerence
Learning in placements?
Social learning- sometimes poor teaching
Unstructured learning unsupervised
performance –learning by osmosis
Self-directed practise – reinforcing
poor techniques if unsupervised
What is simulation?
• Simulation is defined as a:
“real world event that that represents a referent which then
draws its essential meaning from that referent”
• Unlike a simulator:
“a simulator is comparable to a genetic code, and a simulation to
the realization of that code into the living organism”
Crookhall, Oxford and Saunders (1987)
History of simulation
• Jousting, chess, war-gaming, military
exercise, Aviation
• 1832 – Anatomy Act
• 1960’s – SimONE
• 1980’s –GAS
• 1990’s – Surgical haptic simulators
• 2000’s – HPS/ECS
• 2010 – 3G/iStan
Defining simulation types
• Wargaming
• Military training
• Aviation
• Jousting
• Nuclear industry
• Chess
• Space programme
• Emergency services
• Tribal dancing
• Forensics
Simulation as a concept
There are many terms that are afforded the term
simulation, including:
• Low fidelity manikin
• Haptic systems
• Hi Fidelity manikin
• VR
• Part task trainers
• Simulated patients
• Games (driving
rehearsal)
• Multimedia
Hi fidelity simulation advantages
• Draws referent from clinical practice (context)
• Aims to facilitate suspension of disbelief
• Allows for 4D teaching (time)
• Allows for repetition and rehearsal
• Stress innoculation (covert sensitisation)
Benefits of simulation
• Patients are not exposed to
complete novices
• Safe environment where
mistakes become learning
opportunities
• Complexity can be altered
according to the needs of
the student
• Self efficacy can be built
before contact with real
patients
Benefits of simulation
Students can:
• repeat the skill as often as
necessary to develop
confidence
• learn at their own pace
• experience being ‘on the
receiving end’
• express their fears and ask
‘difficult’ questions
• make mistakes and appreciate
the consequences without
harm to the patient
Hierarchy of skills learning
Supervised clinical practice with feedback
10
9
8
Learning in simulation with feedback
7
6
Unsupervised clinical practice
5
4
3
Demonstrations & DVDs
2
1
Manuals and books
0
Hi fidelity simulation disadvantages
• Adrenaline gap
• Uncanny valley
• Fear / upset
• Manpower hours
Practise makes perfect
Practise makes permanent!
Only well supervised practise with
constructive feedback
makes perfect
Simulation as an accepted adjunct to
learning?
•
•
•
•
•
•
Bristol Enquiry 2002
NMC
CODP
CoP
HEFCE CeTL’s 2005
2008 CMO report
CMO report 2008
Anaphylaxis simulation
Theory – practice dichotomy
• If used correctly simulation will facilitate
classical conditioning (2nd nature)
• Objective outcome measurement (Anne vs
iStan)
• Development of communication and
psychomotor domains
Future??